Cerus Corporation, Concord, California, USA.
Department of Pathology and Laboratory Medicine and Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA.
Transfusion. 2024 May;64 Suppl 2:S136-S145. doi: 10.1111/trf.17774. Epub 2024 Mar 3.
Hemorrhage is a leading cause of preventable death in trauma, cardiac surgery, liver transplant, and childbirth. While emphasis on protocolization and ratio of blood product transfusion improves ability to treat hemorrhage rapidly, tools to facilitate understanding of the overall content of a specific transfusion strategy are lacking. Medical modeling can provide insights into where deficits in treatment could arise and key areas for clinical study. By using a transfusion model to gain insight into the aggregate content of massive transfusion protocols (MTPs), clinicians can optimize protocols and create opportunities for future studies of precision transfusion medicine in hemorrhage treatment.
The transfusion model describes the individual round and aggregate content provided by four rounds of MTP, illustrating that the total content of blood elements and coagulation factor changes over time, independent of the patient's condition. The configurable model calculates the aggregate hematocrit, platelet concentration, percent volume plasma, total grams and concentration of citrate, percent volume anticoagulant and additive solution, and concentration of clotting factors: fibrinogen, factor XIII, factor VIII, and von Willebrand factor, provided by the MTP strategy.
Transfusion strategies based on a 1:1:1 or whole blood foundation provide between 13.7 and 17.2 L of blood products over four rounds. Content of strategies varies widely across all measurements based on base strategy and addition of concentrated sources of fibrinogen and other key clotting factors.
Differences observed between modeled transfusion strategies provide key insights into potential opportunities to provide patients with precision transfusion strategy.
出血是创伤、心脏手术、肝移植和分娩中可预防死亡的主要原因。虽然强调方案制定和血液制品输注比例可以提高快速治疗出血的能力，但缺乏有助于理解特定输血策略整体内容的工具。医学建模可以深入了解治疗中可能出现缺陷的地方和临床研究的关键领域。通过使用输血模型深入了解大量输血方案 (MTP) 的总体内容，临床医生可以优化方案并为未来出血治疗中精准输血医学的研究创造机会。
输血模型描述了四轮 MTP 提供的单个回合和总体内容，说明血液成分和凝血因子的总量随时间变化，与患者的病情无关。可配置的模型计算聚合血细胞比容、血小板浓度、血浆体积百分比、总柠檬酸克数和浓度、抗凝剂和添加剂溶液的体积百分比以及凝血因子：纤维蛋白原、因子 XIII、因子 VIII 和血管性血友病因子的浓度，由 MTP 策略提供。
基于 1:1:1 或全血基础的输血策略在四轮中提供 13.7 到 17.2 升的血液制品。基于基础策略和浓缩纤维蛋白原和其他关键凝血因子的添加，所有测量值的策略内容差异很大。
模型化输血策略之间观察到的差异为提供患者精准输血策略提供了关键见解。
